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bandage contains sufficient starch to make a smooth, firm dressing when dry, and it is sufficiently light and porous to be the coolest and most comfortable bandage which a patient can wear; and we must never forget that confining an eye with too bulky a dressing but promotes the growth and multiplication of the micro-organisms which are always present in the conjunctival sac. For the same reason it is necessary to re-dress an injured or operated eye at least once in twenty-four hours, unless there is some unusual circumstance making it desirable not to disturb the eye for a longer time. It is very easy to be less careful in making the after dressing of any wound than we were at the time of the operation or in applying the first dressing, and we should be constantly on our guard not to omit any detail in conection with any subsequent dressing, which we insisted upon as proper in preparing the eye for operation, or in making the primary dressing. After an operation or an injury in which the eye has been opened it is best to bandage both eyes for the first two or three days and the patient should not move about much. Vomiting, coughing and sneezing after such operations are to be avoided if possible, vomiting being particularly disas
If the dressing or cleansing of an eye is intrusted to a nurse, we must insist that she observe every detail of asepsis and we should follow her through one dressing to see that our instructions are understood. We should not fail to caution her that any discharge from an eye may be the source of infection, and that she must cleanse her hands after as well as before every dressing. If two or more patients are being cared for in a hospital ward, or private home, each one should have his own bottles of eye-drops and his own pipettes, and after his discharge both bottles and droppers should be boiled before being used again. The pipettes should have bulbs of pure gum which can be boiled many times and do not give off fine particles to contaminate the solution as do the white ones. All collyria act better, are more quickly absorbed ar d are more agreeable to the patient if applied warm, and it takes but a few moments to raise them to blood heat by immersing the bottle in boiling water.
It seems a very simple thing to write about,
but there is a best way to apply lotions to the eye. If we attempt to drop the solution upon the cornea the eye is quickly closed, only a fraction of a drop remains in the eye and does little good. If, however, we will have our patient look up while we pull the lower lid down, we obtain a groove which will contain a number of minims of fluid, and holding the lid in this position for a moment or two the solution has an opportunity to diffuse itself in the conjunctival sac and be absorbed by the cornea. Then, if the patient will look down while he tips the head back, we can expose the upper cul de sac by placing the thumb against the upper lid, just below the brow, and pulling up on it. The finger should never press against the eyeball, and the raising of the upper lid should be done with the greatest gentleness if there is a wound of the globe or an ulcer of the cornea which might be ruptured. In making applications to the eyes of babies. and small children, the mother or nurse should sit facing the surgeon, holding the child in her lap. If the surgeon will then take the child's head gently between his knees, he will. find that he is master of the situation.
The application of heat is best effected by the use of light compresses of borated gauze wrung out of hot water, kept constantly at a temperature of 110-120. The compresses should be changed every few minutes for an hour once or twice a day, or for fifteen minutes every three hours. Such fomentations are particularly useful and grateful in cases of inflammation of the cornea and iris.
Cold is best applied by means of iced compresses made by cooling pieces of borated cotton on a block of pure ice. They should be renewed every five minutes. Such applications are most useful in the first twentyfour hours after burns and other painful injuries of the eye. They should never be used in iritis or keratitis. They give great relief in purulent conjunctivitis, if used for an hour a day immediately following the application of the nitrate of silver.
Leeches are undoubtedly helpful in acute inflammatory conditions of the inner tunics of the eye (iritis, cyclitis, etc.), and are best applied to the temple by putting the leech in a test tube partly filled with water and placing the open end of the tube against the skin.
A word in regard to the use of mydriatics,
myotics and cocaine. Atropine is the anodyne par excellence for the eye in practically all painful affections except glaucoma. One or two drops of a 1 per cent. solution (5 grains to the ounce) every three hours should be the maximum dosage. Its use promotes resolution in keratitis, relieves the pain and promotes the healing of corneal ulcer, and is essential in iritis to relieve the pain and prevent adhesions by dilating the pupil. Eserine contracts the pupil and relieves the pain of glaucoma and is useful in marginal wounds and ulcers of the cornea by contracting the pupil and getting the iris out of the way. Cocaine is still the best local anesthetic we have in eye surgery, but should never be used simply for the relief of pain in an eye, for the lasting but a few moments, and its continued use is destructive to the corneal epithelium.
Rest in bed is essential to the success of reason that the anaesthetic effect is transient, some eye operations and should be insisted upon for the first twenty-four or forty-eight hours after perforating injuries to the eye. Such a patient should wear a stiff mask (Dr. Ring's) or a wire gauze protection over his bandage at night, and his movements should all be made with gentleness and deliberation. His food should be nutritious but soft and easy of digestion. After cataract extraction I order a liquid diet for the first twenty-four hours. I do not believe in confining the bowels in these cases, but give my patients sufficient laxative medicine to insure an easy movement daily. It is absolutely essential that patients having both eyes bandaged, especially old people, be entertained and amused. In all cases of inflammation of one eye the use of the fellow eye for near work must be prohibited.
The care of complications depends so much upon individual conditions that only general directions can be given. The following signs. may warn us that things are going wrong: (1) Rise in temperature. (2) The continuance of pain. (3) The presence of discharge. (4) The swelling of the lids.
One of the simplest accidents after an operation or dressing may be the detachment of an eyelash which gets into the conjunctival sac, causing considerable irritation. It should of course be removed at once and the eye flushed with boric solution. Spasm of the or
bicularis may occur from irritation of the bandage and the lashes of the lower lid be brought in contact with the eye by turning in of the lid. Painting the lid and the skin immediately below with contractile collodion may afford relief, but it may in some cases be necessary to substitute a shade for the bandage in order to stop the spasm. Sometimes a stitch has been found necessary.
Iritis is a frequent complication after perforation of the globe, and, like suppuration, usually signifies infection. It manifests itself four or five days after the injury or operation by pain, swelling of the lids, lacrimation and intolerance of light. Leeches, to the temple, hot fomentations and atropine are the remedies indicated.
Suppuration of the wound is the most dreaded of complications and frequently means the loss of the eye. The eye becomes painful and bloodshot, the lids are swollen and the wound looks gray and is bathed in pus. Sometimes thorough and repeated disinfection followed by dusting of the wound with iodoform, and the use of hot applications, will stop the destructive process, but if these measures fail the application of the actual cautery to the suppurating area is our best remedy, after which the disinfection and fomentations should be continued until the danger is passed. A nourishing diet and stimulants are indicated. in such cases, and pure air and cheerful surroundings should not be forgotten. 31 Washington St.
PERNICIOUS MALARIAL FEVER IN A NEW-BORN CHILD.
BY VICTOR CADWELL, M. D., POPLAR BLUFF, Mo.
As active malarial symptoms in the newborn are rarely observed, the present case may prove of interest. Early in the afternoon of February 24 I was called to see Mrs. R., multipara, 23 years of age. She had been suffering for several days with a tertian type of malarial fever, having had her last chill dur. ing the forenoon of the day I was called. Her temperature was 103.5 degrees and she was just beginning to perspire. There was a history of several similar attacks in the past two
years. The patient was pregnant and thought herself six weeks beyond term, but from the meager data I could obtain I judged that she was just about at term. She complained of general muscular soreness and dragging pains in small of back. Examination showed a cervix very much softened and a slightly dilated
At 4 o'clock the following morning I was called hurriedly and arrived just in time to deliver a ten-pound boy. Both mother and child did well, the child being apparently in a perfectly normal condition, passing the usual amount of meconium and urine, crying lustily and nursing and sleeping well. On the morning of the following day the mother had her regular chill, despite anti-malarial remedies. At the same time the child became cold, its face blue and pinched and the fingernails blue. This condition lasted a variable length of time, according to the testimony of those present probably half an hour, and then passed off, leaving the child with an intense fever. On my arrival I found the child comatose and cyanotic, the respiration rapid and labored, with a rectal temperature 105.5 degrees, and presenting a picture of acute pernicious madarial congestion, which ended shortly in death, in spite of active rectal medication and stimulation given with only faint hope of success. Unfortunately no blood examination could be made for the plasmodium malariæ, but it seems to me there can be no doubt as to the character of the trouble.
A Cook Tour to the International Medical Congress.
The following circular letter, signed by several prominent Chicago physicians, has been sent out:
"Chicago, March, 1897. "Dear Doctor:-It is believed that a considerable number of American physicians will visit the twelfth International Medical Congress, to be held in Moscow, August 19-26, 1897. As all those who wish to attend the congress have a common objective point, it is thought that they can be associated to advantage in one or more excursion parties. In this way the social features of the trip will be enhanced, and each individual will be surrounded by those who are personally congenial. By such association better accommodations can be secured and at considerable reduction in price. Additional security will also be attained, as parts of the trip, which include comparatively unfrequented routes of travel,
will be under the charge of a traveling director who is thoroughly conversant with the languages and customs of the country visited.
"As there will doubtless be some divergence as to choice of routes, depending on individual inclination and previous opportunities for foreign travel, several routes have been selected. By reference to the accompanying itinerary it will be seen that in these, although separate for a portion of the journey, the principal points are visited together.
"Final arrangements are in the hands of the well-known tourist agents, Thomas Cook & Son, thus affording ample guaranty that the tour will be satisfactorily conducted. Yours very truly
"Nicholas Senn, M. D.,
A pamphlet descriptive of the itineraries may be had by addressing Messrs. Thomas Cook & Son, No. 261 and No. 1225 Broadway, New York, or No. 234 South Clark street, Chicago.
First Aid Instruction on English Roads.
Recognizing the great advantages of instruction in "First Aid," the directors of the Great Western have decided to further encourage the work of the St. John's Ambulance Association amongst their staff, by the establishment of an organization which will arrange, at the cost of the company, classes at various points of their system, which extends over 2,500 miles of country. The members of the staff take the greatest interest in the work, and since November last upward of 1,500 of the company's employes have given in their names for instruction in rendering "First Aid." This number is in addition to some 2,500 men who have already undergone training and are duly qualified by the rules of the St. John's Ambulance Association to render "First Aid." These represent all grades and departments in the service, and many of the classes already examined have been complimented by the examiners on the high degree of efficiency attained in a knowledge which is so necessary and valuable, not only in the interest of the members themselves, but also in that of the traveling public. Her Royal Highness Princess Christian, president of the Great Western Railway Center, who has always taken a deep interest in the work, has consented to present, in the month of May next, at Paddington Station, the certificates to the successful candidates in the London district. Transport.
PUBLISHED EVERY OTHER TUESDAY BY
talks to railway men upon the subject of railway surgery. It is obvious, however, that the greatest difficulty will arise in the effort to so simplify technical matters as to avoid confusion and render them practically useful.
The Railway Age and Northwestern Railroader (Inc.), Teaching is an art which it is apparently im
FIRST AID TALKS TO RAILWAY MEN.
In other columns of this issue we publish a lecture delivered by Dr. James G. Hunt, medical examiner for the New York, Ontario & Western Railway Company, before the railway branch of the Young Men's Christian Association at Utica, N. Y. The Y. M. C, A. has a building in Utica which is open day and night for the comfort and benefit of the employes of all railways entering Utica. Educational classes and courses of lectures have been arranged which must be of great interest and value to those attending. From a little circular which Dr. Hunt has sent us we note that talks have been given upon the subjects of "Color Blindness," "Railroad Signaling." "Electricity," "Qualities that Win," and "Railway Surgery." The railway men of Utica are certainly to be congratulated upon having such rare opportunities, and we quite approve of
possible for some men to acquire. Certain natural gifts seem to be necessary, and truly successful teachers are consequently rare. We believe that talks upon "Railway Surgery," for the benefit of railway men, should be rather informal than otherwise, and the men should be requested to interrupt the talk and ask questions wherever necessary to clear up points which are not presented in proper form for their understandin.g We who are constantly thinking of scientific matters in technical form art apt to forget how utterly unintelligible language, which is perfectly familiar to us, is to the mind untrained in technical matters.
In addition to the responses received from railway companies in the matter of transportation to the annual convention which were published in our last issue, other replies have since been received, including the following:
Illinois Central Railroad.-Referring to your favor 10 inst., in reference to the annual convention of the National Association of Railway Surgeons, to be held in Chicago May 4 to 6, 1897, the practice of this company in the past has been to issue passes to its own surgeons going to these conventions, and to surgeons of other roads upon receipt of request from the proper officer. We shall probably do the same this year.-J. T. Harahan.
Chicago & Alton.-Answering your favor of April 10, addressed to Vice-President Chappell, the Chicago & Alton railroad will, as heretofore, transport the delegates to your national convention, upon the request of the general manager or general superintendent of the railroads upon which such delegates are employed. The delegates can secure transportation by presenting their membership certificates properly indorsed by the general managers or superintendents of the roads to which they belong, at the passenger office of this company at Kansas City, St. Louis and Peoria.— J. H. Wood.
We quote these two letters in particular, as the Wabash railroad having already responded, the three main lines between St. Louis and Chicago now stand ready to furnish necessary transportation, and we would suggest that as far as possible applications for transportation
from St. Louis to Chicago and return be distributed between the three companies. The travel from St. Louis will probably be heavy and too much of the burden ought not to be thrown upon any one of the three lines.
OUR EASTERN FRIENDS.
In an editorial in a recent issue of the International Journal of Surgery, the editor, Dr. George Chaffee, of the department of railway surgery, after announcing the coming meeting of the National Association of Railway Surgeons and the topics which were suggested by The Railway Surgeon as proper subjects for discussion, writes as follows:
"Why is it that the National Association of Railway Surgeons has never held a meeting in New York City? Have the officials and surgeons of our eastern lines ever asked themselves this question? It is because railway surgery in the East is in such a backward state from lack of organization of surgical departments that the executive committee of this beneficent association, with its member-ship of nearly fifteen hundred surgeons, has, so far, felt rather delicate about accepting an invitation to call a meeting in this city. Here is a society of surgeons organized for humane. and scientific purposes; the result of their efforts is broad and far-reaching, affecting favorably the economic, social and relief interests of employer and employed.
"In May of 1892, at the Old Point Comfort meeting, President Dr. J. H. Murphy, in responding to the address of welcome, said: 'I remember very well during the war when we tried hard to get to Richmond, but we could not do it [laughter], but yesterday we had no trouble whatever to get there. My friend, Dr. Outten, has written not to one, but to every railroad in America, and all of the roads except one have said: "We will give you transportation; you belong to us and we belong to you.”
"If a staff of fifteen hundred specially trained surgeons holding themselves in readiness for immediate service with our army of railway employes, and in case of disaster on any line, was entitled to transportation over all American lines except one in 1892, and from Cincinnati and Richmond to Old Point over the C. & O., alone, by two special trains, is not that staff again entitled to the same courtesy from the dozen or more lines terminating in New York City and vicinity?
"The six hundred surgeons in attendance at Old Point were pleased to see General Manager Stevens standing on the platform before them. His remarks were not lengthy, but
they came direct from the heart of the speaker, and were appreciated by the surgeons. The management of the C. & O. had shown by its generosity and by the appearance of Mr. Stevens before the association that it appreciated railway surgeons and their work, and it was an ad. which did that line no particular harm. The general managers of eastern lines would do well to follow Mr. Stevens' example, by inviting the National Association of Railway Surgeons to convene in New York City, and by personally attending some of its sessions.
"We are decidedly too far behind the times. Perhaps more missionary work is necessary. Railway officials and surgeons of the East, are you doing your full duty to yourselves, to employes, and to your corporations? Is it right for us to remain quiet and allow railway surgery in the East to continue in this back
"In 1891, when the call was made to organize the New York State Association of Railway Surgeons, we felled the first tree in the eastern forest of railway surgery. For five years we have continued our pioneer work in this line, ably assisted by our associates and members, but we are not satisfied to let the good work rest where it now stands. All along the work of our campaign has been one of education. Why? Because the situation required it. This is still the line to be followed. The gentlemen who compose the executive departments of our eastern lines are in need of more practical knowledge of railway surgery and of the relief and hospital department, and for that purpose we invite the coöperation of the national association in the form of an annual meeting to be held in New York City."
Dr. Chaffee knows exactly what he is talking about, and the good work which he and other friends of the National Association of Railway Surgeons are doing for railway surgery in the East must ultimately bring about a full and complete recognition of the value of organized surgical departments and a proper regard for the work which has been and is being done by the National Association of Railway Surgeons.
THE COMPLETE PROGRAMME.
The following is the complete programme for the coming meeting of the National Association of Railway Surgeons:
FIRST DAY--MORNING SESSION.
Tuesday, May 4, 10 a. m.
1. Opening of the Tenth Annual Conven